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    IUD Issues: Zero in with ultrasound

     

    Figure 4 3D coronal view of the uterus showing normal placement of the IUD. The brightly echogenic string is visualized looping up and crossing over the shaft of the IUD and then extending toward the lower uterus (arrow).Sonographic evaluation of the positioning of an IUD is greatly enhanced by identification of the coronal view of the uterus, a plane that is not often obtainable using 2D imaging. Three-dimensional sonography allows visualization of the coronal view of the uterus with minimal post-processing manipulation of the uterine volume and is critical for determining malposition of an IUD.4-10

    If an IUD cannot be visualized by 3D pelvic sonography, a secondary imaging procedure such as abdominal/pelvic x-rays or computed tomography may be necessary.10,11

    Technique for coronal view

    Abuhamad et al. have demonstrated the ease of attaining the coronal view of the uterus in a standardized fashion.12 To perform this so-called Z technique, follow these key steps:

    • Obtain a midsagittal view of the uterus and magnify the image so that it includes the corpus and lower uterine segment. Obtain a 3D image and display it in a multiplanar view so that 3 orthogonal planes are on a single frame. Configure the display so that the A frame is the acquisition plane (sagittal view), the B frame is the transverse view and the C frame is the coronal view. A “reference dot” located at the same anatomic point in each plane is the rotational point around which the image is rotated (Figure 5A).

    • Place the reference dot in the midpoint of the endometrial stripe in the sagittal plane of the uterus, which should be in the “A” frame.

    • Using the Z rotation, manipulate the sagittal view of the endometrial echo so that it is horizontal (Figure 5A).

    • Place the reference or marker “dot” in the midpoint of the endometrial stripe in the transverse plane of the uterus, frame B (Figure 5B).

    • Using the Z rotation, manipulate the endometrial stripe so that the short axis of the transverse plane is horizontal.

    • You should now see the mid-coronal plane of the uterus on the C frame (Figure 5B).

    • Use the Z rotation to manipulate the image so that it is demonstrated in the conventional orientation.

    • You can then display the image as a single plane for optimal evaluation.

    The coronal plane can also be demonstrated with a rendering technique using the same principles. In that case, adjustment of the position of the endometrial echo in boxes A and B is identical; however, the render mode is used and the line of interest is placed over the endometrium (Figure 6).

     

     

    Thomas D Shipp, MD, RDMS
    Dr Shipp is a Vice President with Diagnostic Ultrasound Associates, PC, Brookline, Massachusetts, and a Sonologist and Associate ...
    Bryann Bromley, MD
    Dr Bromley is a Vice President at Diagnostic Ultrasound Associates, PC, Brookline, Massachusetts, and a Sonologist and Professor of ...

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